tv Politics Public Policy Today CSPAN September 22, 2012 6:00am-7:00am EDT
, where people are living and going there. i think there's probably some things with all these plants that have the flexibility to design how we're got to do this on their own. they will develop teams to care for patients. and figure out what the right component is of doctors and nurses and home health aides and others. i agree that technology is going to be i agree that technology is going to be critical. it is going to be critical in terms ofs electronic health records, to get everyone on the team together, to be able to coordinate with the patient outside, but other technologies are going to begin coming online. whether they are wireless to monitor patients at home. using email to communicate and other mechanisms. i think the system they have created in oregon is going to help us run 15, 16 experiments in each of the communities.
maybe not all of them are going to succeed. some will succeed. very well i'm sure. some will have growing pains. we can't expect, you know, to bat 100%, 1,000%, but we're going to learn from this going forward. what works? what actually is able to control congestive heart failure. what is able to control diabetes or emphysema. the big cost drivers. you have to give oregon credit. they were out there in the 1990'sing that they had to cover everyone in medicaid and try something bold recognizing that we have a different system and they are trying something bold. unlike many placers this actually putting money down on this because the penalty if they don't succeed to the federal government are pretty substantial, the hundreds of millions of dollars as you heard from the governor, the state already has fiscal problems. that is a pretty big bet that
they can actually transform the system and i think it is this kind of bold system that is going chart the future for us and as the governor said, we can't stay in the current system, exactly the right combination to go forward, we have a lot of inklings and interesting innovations but trying them out in the whole state is really, really novel and path-breaking and i think oregon along with three or four other states is really blazing the future for us. >> thanks. as you're talking about other states and their reform efforts, i would like to take an opportunity to plug a report out today. it is not looking at state experiments but it is looking at private sector experiments from payer driven and provider driven and patients that are in medical
homes and a.c.o.'s and bundle payments. what my colleagues and i found that was so interesting, we actually spoke about the number of organizations throughout the country working on these. every single thing they were telling us what they needed to do, echoing what they the governor said today. making sure they thought about a person's health beyond a hospital, beyond a doctor's office. so having said that, i would like to explore that shaw little bit more. how, especially as clinicians, how both of you see the movement from fee for service moving towards more of a proactive approach engaging patients more outside the walls of what we picture now as being the health care system? >> ladies first. >> again, i think there is no
doubt that the existing system today is not sustainable it is a governor mentioned, and as we look toward the future, we think about what is sustainable. how are we going to be incentivized and rewarded for value versus volume. technology certainly has a place to serve in that. as an enabler to all the things we're talking about. you talk about the c.h.f. patient, how do we keep them out of the hospital? as you look toward technologies and the future, we think about modern technologies, ways for patients to be engages in ways that they are not. the average patient's visit about eight minutes. they have to discuss treatment, medicines. a lot of this does not roll off the tongue for a lot of my payments. if i can give them tools so when
they go home to digest the information, they are going to be better able to take care of themselves. they are going -- i am going to do a much better job taking care of my population by having some of the quality matrix and data available. i'm also going to know how i'm doing and i'm going to be held accountable. being able to understand better why they were in a hospital. what worked, what didn't. an air conditioner could have gone a long way in that eight-minute visit. as we think about the future, i think it is very much a enabler to that paradigm that we're trying to build. >> i would echo that. i.t., all sorts of new technologies, whether it is the monitor at home or getting
patients to increase compliance and engagement, all of those are necessary. they are going to be absolutely critical for the system. they make sense, only in the system that pays differently and pays to keep patients healthy. just to take one simple example. i vividly remember we used to send patients out with the staff, especially patients are illness like congestive heart failure or emphysema with prescriptions and to go get them filled and to take four or five pills three times a day knowledgeably and reliably. no one sat back and said that is idiotic. no one stepped back and said is there a better way? a lot of patients, 1/3 of patients don't even fill the
prescription prescriptions and many of them don't even take them right. is there a better way? can we get the medications to the house so they don't have to take the initiative to fill them? can we give them something that will help them remember to take the pills and what pills to take. we have a lot of companies coming one different way s of dispensing pills, pill jar tops so they alert the doctor or the pharmacist. these are the kinds of technologies we're going to begin using. do we know how the use them yet perfectly and optimaly? no. we're not going to have these experiments without legislation and without waivers that really try them out, recognizing that the patients with chronic disease who are costing us a lot, where we have deficiencies in quality where we really need
to focus this care coordination model better. i think that is going to be pivotal. a lot of that is going to be with technology and a lot of it is going to be with people. forming the relationship that the patient trusts when someone calls at the other end that say we know your weight is going up. here is how i would adjust your medication. are you eating right? are you taking that diuretic? these transformations are going to be critical. unless we start somewhere, unless we get sufficient amount of payment change and the sufficient amount of paris to change, whether it is -- payers to change or whether it is medicare or medicaid, if a quarter are saying this but 3/4 is paying the other way, it is very hard to make the move. i've heard numbers between 30%
and 60% need to begin talking in one direction for the system to really transform. we're getting to that tipping point in places like oregon and in other states, massachusetts, illinois. but we need to have more groups on the public sector and the private sector. i think the discussions that the governor is beginning to have that the private payer is very pivotal to make this a real success. >> are can i just add something? >> absolutely. >> to the point of going beyond four walls beyond the hospital, it is about extending care. technology is easy. it is the people part that is complicated. getting to the root of the matter, thinking outside the box, thinking about innovation, where to look. how to think differently about the paradox is critical. that is one of the things in addition to technology advances
and health records that we talk about, the other theme i think that runs through it and you can see it from the governor's remarks as well, with his leadership is the importance of having strong physician leadership at each level. you know, once a state or a payer or a provider or organization decides to start implementing these reforms, what type of can we rely on the start getting the word out for that organization down to different provide hears the they are caring for individuals and down to individuals in their office such as nurse practitioners and other care coordinators. >> i think you're absolutely right. i'll tell you one of the things that i think distinguishes this period of time from, say, the period of time after the failure of the clinton health care reform in the 1990's, where we did have a moderation in health
care costs, which turned out not to be sustained, lasted for about five years and then they came back with a vengeance. it is for tirs time the health care system is really, really engaged. in the 1990's, --s and hospitals were mightily resistant. did not try to figure out a new care model. everything was a battle. today i see it when i go out and talk to people in hospitals and physicians, very, very different. they do recognize, as the governor said, that the system is broken. they have a lot of complaints about the fact that the care model they are after does not match up with the care model in many cases and we're stuck in this gap, but they are very committed for reforming the system and transforming it. you know, some of it is because -- much of it is because of the affordable care act. they have to do different things
on readmission and patient sachte. -- safety. they are being pushed but now they are voluntarily working hard and trying to figure out how to improve their model. attitude is very, very important and i think the attitude among young physicians is completely different. one of the things is they were raised on technology. they use technology all the time. cd that they would have a paper record, horrific. they would not know what to do with it. i think we're going to see a lot more uptake, especially among -- and push, on the system, especially among younger doctors for this. i would say that one other element, which i do get frighten about is medical schools training and the kind of education we have created has not kept up with these changes
and i think over the next decade or so they are going to have to transform the way they are educating students because it is going to be a new deliverly system, team-based outside of the hospital. i think that transformation has yet to occur and to be honest, a full national discussion on how we transform education to match the kind of delivery system we need has yet to occur. i would throw that out as the next step governor. >> and with that shout out the governor, we would like to bring him back up here for some question and answer, please.
>> my name is andrew. not only am i an oregon voter, i will probably vote governor kits has beener. -- kits has beener. -- kitzhaber. just a few years ago, the legislature was lobbed in partisan gridlock. they got nothing done, just like congress is today, and somehow in the past few years, you or your counterparts in the legislature were able to find a way to work together and create bipartisan support for things that seem like common sense but in today's congress and in yet's oregon legislature just didn't work out. -- -- yesterday's legislature just didn't work out. can you provide some insights to how you did that? >> i don't think it is robert
science. it is having a -- rocket science. it is having a vision. there wasn't a lot of room to solve problems. we could not buy our way out of this. we were in a revenue reduction mode. i change it from how do we close the deficit and spend the money that we have in order to get different results. i ran on that. the day i got elected, i called the speaker elect and the co-speakers, the budget writing people out to the governor's house and i walked through what i had laid out. said what do you think? where do you agree? where do you not agree? so we created that. we met almost every day. i brought them into my office. surprise, surprise, relationships actually developed there.
there was a trusting relationship there. they were able to demonstratesoevering these problems depends on the people. you know, i'm real proud of what we did up there. i don't think that is unique to oregon that it requires a certain kind of leadership and commitment to move beyond partisanship to solve problems that face everyday americans or oregonians. >> there are a few people in the back. >> bob with the institute of social medicine and community health. the example of an air conditioner for a patient with congestive heart failure is a really nice example of secondary prevention, but i'm wondering if the state is doing anything about primary prevention? and around community health
planning, around addressing the social determinants of health, not just for patients who already are easily identifiable as high risk, but patients or people who are likely to develop the health problems so that we can really get a more effective delivery system. >> that's a great question. obviously a childhood obesity and diabetes would be a great example of that. there is a crosswalk between the reforms we have taken nonhealth care and what we have done in the education arena. we pretend that kids don't exist until they get to kindergarten and then it is segmented. we created a board that creates a single alignment of budgets and government from prekinder
gart on the childhood education. that's where the gap occurs. that's where the huge despair tiss among community s of color occur. we have dwropped a performance-based childhood delivery model. the family resource manager essentially identifies the families at risk and brokers the resources they need. that would include nutrition and a whole host of other things. there is a crosswalk between health care and education. the two places kids always show up are at school and the hospitals. hospitals are now screened for p.k.u. they don't scan for socioeconomic risk factors. the c.c.o.'s are very interested in this. under the model, if they can
reduce the amount of kids with diabetes, they will have a lot more resources. you have to take the paradigm outside the hospital. the real health benefits occur in the community, preventing chronic diseases from developing. once we do, we need a community-based method in order to manage them. i'll just say one other thing. this requires a fundamentally different workforce. it is very important because the health care industry grew through the recession. they added jobs. a lot of those jobs were people running m.r.i.'s that didn't need to be run. we are going to retrain those people as community health workers, well paid professionals who essential job to broker health for people as they move through the system >> i think what you divide is a
very important divide between primary intervention and secondary intervention. the money is in tertiary prevention, taking people with chronic illness. primary prevention absolutely critical, especially, first of all, the longer you look, also in things like vaccines, which we know save money, relatively short order. the fact of the matter is most primary intervention, whether it is obesity, exercise, -- public health measures best known the community and i don't want to say those two r-two separate -- because as the governor points out we are trying to bring them closer but we should also be clear those are not going to save a lot of money in short term at all. if you want to save money and
improve quality in the five-year time horizon than the governor is under, you have to think about people who have established chronic illness. that is not to say prevention is not important. believe me, in our country it is really important. the first primary prevention is not really affected by changing in payment models. you're not going to change it. i would say one last thing. the affordable care act invested pretty heavily in school-based clinics. we don't have enough of them if you want my honest opinion. they are very, very essential for identifying kids, shortening the absence from school to make sure they can get services so i think this is one area where again creativity and innovation is made possible but the
affordable care act. >> you know, the fact is that only 10% of your lifetime health is the result of the medical system. 90% is genetics. lifestyle behavior and socioeconomic issues. zeke is right. to solve the immediate crisis you v to change the paradigm for treating people with chronic illnesses. you have to reduce the burden of chronic illnesses coming into the system. i would argue it has nothing to do with health care but everything to do with health. that is the biggest paradigm. to keep people healthy. if that is the case, you have to investsome community-based systems. essentially, hopefully within about two years, we have integrated that front-end piece which has huge impacts in the
criminal justice system as well. >> we got to crack down on china when they cheat. they manipulate their currency. [applause] they steal patents and designs and counterfit good. i know they want to be a responsible partner. they have to understand they can't take away jobs on an unfairway sis. >> he made money investing in companies that uprooted from here and went to china. pioneers. now you can't stand up to china when all you have done is sent them our jobs? >> watch and engage with c-span as the campaigns move toward the november elections. international issues and foreign policy there be focus of debate number three. the first debate on domestic issues will take place on november 3. audience members will get their
chance to ask questions on a town hol debate on tuesday, the 16th and the final debate will take place on the 22en. also watch the vice-presidential debate on october 11. >> republican congressman and vice-presidential candidate paul ryan spoke today at the aarp annual conference in new orleans. he talked about social security and medicare and his plans with presidential candidate mitt romney to protect the programs in the future and repeal president obama's health care law. this is about 35 minutes. [applause] >> hey, everybody. how are you? thank you very much m. jane, everyone here, i appreciate the introduction and this chance to be with you in
new orleans. you have had a busy convention. i know that many of you may time yesterday to volunteer around this great city. it was very much in the spirit of a group whose motto calls to the service of others. this country honors those who serve. we have set aside today as a nation to remember those men and women in uniform who were taken as prisoners of war or went missing in action. to honor those who have endured hardship and to remember those who remain missing, i like to begin with a moment of silent prayer, if you will. i thank you for that. thank you for your kind hospitality this morning.
life at 50 +. i am not there yet, but i am told that it will come before you know it. [laughter] i'm a little more focused today on my 40's and in particular, the next four years. i have given a good deal of thought to later seasons in life. not just as someone with his own family to look after, but as someone with public responsibility as well. many in washington who have held office long before i came along made some big and fundamental commitments. it will fall on my generation to make sure that those commitments are kept. the challenges would be enormous under any circumstances. they are even tougher in a bad economy. many americans over 50 are
wondering, will i lose my job before i am ready to retire? will the health and retirement security programs i have been counting on be there for me? what will happen to my savings if the value of the dollar keeps going down? what kind of nation are we leaving to our kids? you are right to ask these questions. you are right to worry. years of empty promises by both political parties are threatening the security of our economy. you're right to demand honest answers from those who are asking for your vote. mitt romney and i share your concerns. we respect you enough to level with you. we respect all the people in this country enough to talk about the clear choices that we face on medicare, social security, and the economy, and the kind of country that our children will inherit.
i'll warn you ahead of time. these are very serious challenges. sometimes the math can be a little bit overwhelming. let's just start with simple subtraction. 2012 - 50. if you're turning 50 this year, you were born in 1962. a dawn of a new american era in civil politics. jfk, civil rights, vietnam. by the time you were learning long division, neil armstrong was walking on the moon. the government was making promises to older americans. when johnson signed medicare into law, he pledged that no longer with older americans be denied the healing miracle of modern medicine. no longer will young families see their incomes and their own hopes eatten away simply because they are carrying out their deep
obligations to their parents and two uncles and to their aunts. you see, there are two sides to that promise. their obligations to the old and young alike. we must honor both. our nation faces a turning point. government mismanagement and political cowardicethreatening both sides of his are pledge. seniors are threatened by obamacare, a law that would reel benefits in real-time from real people. meanwhile -- meanwhile, younger americans are burdened by a growing debt and diminished future. here is the good news -- by embracing common sense reforms right now, we can get ahead of the problem. and keep propses people have organized their lives around.
if we reform medicare for my generation, we can protect it for those in or near retirement today. [applause] the first up to a stronger medicare is to repeal obamacare. it represents the worst of both worlds. i had a feeling there would be mixed reaction so let me get into it. it weakens medicare for today's seniors and puts it at risk for the next generation. first, it follows $716 billion out of medicare to pay for a new entitlement we did not ask for. second, it puts 15 unelected bureaucrats in charge of medicare's future. let's talk about each of these in turn. you might not have heard this
side of the story. by now you have probably heard a lot of claims and counterclaims about the president's raid on medicare. the president said this would strengthen the program. he said it would improve the program's solvency. ladies and gentleman, that is not true. the money was not walled off to stay in medicare. instead, the law turned medicare into a piggy bank for obamacare. you do not have to take my word for it. ask the chief actuary at medicare services. he works for the obama administration. his job is to look after your medicare. last year we invited him to congress to answer a simple question -- if president obama's medicare cuts were used to pay for new spending in obamacare,
how can they also improve medicare insolvency? his answer? they cannot. it is simple. you cannot spend the same dollar twice. his exact words, "it takes two sets of money to make it happen." president obama never provided the other to strengthen medicare. there it is. from the guy whose job is to know it. if anyone tries to tell you that obamacare will strengthen medicare, ask them -- where is the other $716 billion? medicare is going bankrupt. everyone understands this. even president obama said last year, "if you look at the numbers, medicare will run out of money.
we will not be able to sustain the program no matter how much taxes go up." the disagreement is not about the problem. it is about the solution. you might have heard about the approach mitt romney and i would take. i will lay that out for you. you probably have not heard much about what president obama will do. the president doesn't talk much about what obama care would really mean for seniors and anyone who understands the details knows why. people don't like it. the president's health care law sets up something called the independent payment advisory board. it would be made up of 15
unelected bureaucrats. the president said he would appoint experts but none of the 15 are required by law to have any medical training. here is a thing -- as medicare spending grows, this board is required to cut its. unless congress overrides these cuts with a super majority vote, they automatically become law. think about what this means. i know aarp was involved in the annual debate about the doc fix. back in 1997, both parties agree to a deal that included large reduction in fees for doctors who treat medicare patients. it soon became clear that these cuts would make it impossible for many doctors to keep treating medicare patients. every year, like clockwork, congress postpones the cuts.
some of us learned a lesson from that experience. top down, bureaucratic cuts to medicare do not work. providers stop providing care. that is what happens. unfortunately, some democrats learned a different lesson. they never give up on their belief in the top down, bureaucratic cuts. but they did learn that these cuts are very unpopular. obamacare represents a first step in their new approach. they one to take responsibility for these cuts out of the hand of your elected representatives and give it to unelected bureaucrats. they want to let them make the decisions and let them take the heat. this is what that would mean -- the cuts would be so severe, they could jeopardize access to care for beneficiaries.
i deal with actuaries a lot as chairman of the committee. this is what that means in english -- do not proceed with this plan. but president obama says to go forward, forward into a future in which bureaucrats decide it is not worth the money. now you have heard the president's approach. now you have got the full story about the president's approach. let me tell you what mitt romney and i believe. and what we will do if we are elected 46 days from now. when i think about medicare, i don't think about charts and graphs and numbers. my thoughts go back to a house on garfield street in janesville. my wonderful grandma, janet, she
had alzheimer's. she moved in with my mom and me. she felt lost at times, but we did little things that made her feel loved. we had help from medicare. it was there, just like it is there for my mother today. my mother is with me today. she is a senior from florida. [applause] at that time in my life, when my grandmother lived with my mother and me, that is when we grew the closest. i am very proud of my mother. i'm happy she is having a great retirement. medicare is a big part of her security. medicare is a promise, and we will honor it. a romney/ryan administration will protect and strengthen medicare for my mother called regeneration and for mine and for my kids and for yours.
our plan keeps the protections that have made medicare a guaranteed promise for seniors throughout the years. let me be clear -- it makes no changes for those in or near retirement. in order to save medicare for future generations, we propose putting 50 million seniors and not 15 unelected bureaucrats in charge of their own health care decisions. [applause] our plan empowers future seniors to choose the coverage that works best for them. from a list of plans required to offer at least the same traditional benefits of traditional medicare. this system is designed to guarantee that seniors can always afford medicare coverage. no exceptions. [applause]
if a senior wants to choose a traditional medicare plan, she will have that right. we have seen this kind of reform work in medicare part d, the part in prescription drugs. we have applied these lessons and improve upon them. medicare reforms, based on the choice and competition, go back to the clinton administration. experts from both parties helped form his plan. democrats in congress have supported these ideas. mitt and i studied these bipartisan ideas. we have looked at the
numbers. we came up with a plan to save this critical program. we did the same thing with social security. we know it is in trouble and we know what's at stake. if we do not act, today's seniors will face a 25% across the board benefit cut in the heart of their retirements. that is current law. we know what to do. mitt romney and i have put our own plan on the table. we will make no changes for those in or near retirement. for my generation, we can make this program solvent by slightly raising the retirement age over time. [applause] all that we need right now is leaders who have the political will to save and strengthen social security.
when it comes to protecting this program, president obama has come up short. the president has no plan. no plan doesn't mean leaving social security as it is. it means letting it grow weaker. inaction today will mean sharp cuts tomorrow. time and again, this president has ducked the tough issues. he has put his own job security over your retirement security. he said he would be willing to work with republicans, but he has not moved an inch closer to common ground. when it comes to bipartisanship, it is easy to talk the talk, but there is only one man who is running for president at walks the walk. that man is mitt romney.
let me explain why. in a state where 87% of the state legislature was democratic, governor romney got results by reaching across the aisle. bringing people together. crafting solutions that got widespread support. that is how he was able to turn a $3 million budget shortfall into a $2 million dollar rainy day fund. that is the kind of leadership we need if you're going to save and strengthen social security. [applause] protecting social security is personal to me. my dad died when i was 16. a social security survivor benefits helped my family. it helped me go to school.
they helped my mother start a new career. when my dad died, my mom had recently entered her 50's like many of you. she got on a bus and rode 40 miles each morning to madison to go to school. she learned new skills to start her own small business. it wasn't just a new livelihood. it was a new life. it transformed my mom from a widow in grief to a successful, small business woman. her work and gave her hope. it made our family proud. to this day, my mom is my role model. [applause] for people over 50, up retirement should give us a larger goal. economic security is what we seek for all americans.
the last four years have been especially hard on americans who are out of work, but not yet ready to retire. i have met men and women were close to giving up hope that they will ever be employed again. mitt has called long-term employment an economic emergency. he is right. we have not seen a recovery this bad in decades. for many americans, there has been no recovery at all. for people who find themselves without a job before the are ready to retire, starting or joining a small business, there is a promising way to bridge the gap. just like my mom did. president obama's policy has made it hard for small businesses to thrive. the president likes to talk about how he is a champion for small business. but the truth is, if he is elected, he would increase the
tax rate for small businesses permanently. mitt and i think that is the wrong approach. we believe that it is the dreamers and entrepreneurs, the workers and their families and not the government, that built this economy. [applause] they are the ones who will get it growing again and get america growing again. in a romney/ryan administration, we are going to champion small businesses and workers they employed and not stand in their way. [applause] we have got a plan that will reform the tax code, to get rid of special interest loopholes, and limit reductions so that we can lower everybody's tax rates.
simple, fair, competitive. that is the tax code that families and small businesses deserve. that is how you get people back to work. that's tax code that we will deliver. we will also repeal obamacare and replace it with real reform. that is also going to give businesses the certainty they need to start hiring again. and in a romney/ryan administration, american workers and small businesses will start getting the respect they deserve. after all of their hard work, what they deserve is to hear the truth. yes, you built that business. [applause] there is another threat to our economic security, and that is our debt. it is hurting our economy right now. if we do not tackle it soon, it will tackle us.
the president came into office and promised to cut it in half by the end of his term. instead, he added five trillion dollars to the debt and presided over our nation's first credit downgrade. friends, if we continue on the road that europe is on, we will get european results. that means harsh cuts in benefits for those who depend on them, along with crushing tax increases. the federal reserve cannot keep bailing us out forever. they can offer as a short-term fix that comes at a long-term costs. it is our seniors who will literally pay the price. the fed's actions are having an effect on energy and food prices. it forces seniors to stretch their fixed incomes. all this money printing hurt savers. it threatens the future value of our money. seniors are bearing most of the risk.
mitt romney and i will take america off of this dangerous task. we will bring back economic growth. we will cut and cap spending. we will restore america's aaa rating. [applause] we can do this. we still have time to get this right. when i think of the challenges that we are facing, i think of my mom. whether it is mid career worker who has to start over, the senior who relies on medicare today, or at the grandparents to wants to make sure that her grandkids inherit a stronger america. that is my inspiration. because i have a strong example in my own life, i have the unshakable belief in the resilience, wisdom of the american people to solve these problems. for mid-career americans, let's put in a president that a champion of small businesses so people can go back to work.
let's repeal obamacare. let's keep promises to seniors. and for future generation, let's strengthen our health and retirement security program so they can count on them when they retire. let's and grow the economy so that we have opportunities to succeed. let's work to leave our grandkids with a debt-free nation. [applause] friends, it will be a long journey. we can make that journey only together. i asked you to join us in the work to come. your support and the programs you care about have been taken for granted long enough. let's take these challenges as americans. join us and help us. work with us. i know that we can get this done. thank you for your time. god bless.
i would be happy to take your questions. [applause] thank you. thank you. >> thank you, congressman ryan. we have hundreds of questions. i hope you can take it you before you leave us. this one comes from indiana. from donna who asks why are social security and medicare the first thing that people look when deciding to balance the budget? are there other areas that can be restructured to enable savings? >> good question. can everyone hear me? ok. first of all, you have to cut spending in other areas. you have to grow the economy to get revenue to come in. but in the future, it is these programs that become the primary
driver of our debt. let me explain. by the year 2025, three programs -- medicare, social security, and medicaid, with interest -- will have consumed 100% of all federal revenue. why is that? it is really because of demographics and health inflation. what do i mean when i say that? we're going from approximately 40 million seniors to 80 million seniors in one generation. do not forget that these programs are pay-as-you-go programs. when you have 100% increase in your retirement population but only about 17% on the taxpaying population to pay for the benefits and the costs of medicare goes up about 8% per year, there lies your problem. that is why they need to put in place the kinds of reforms.
it is not about balancing the budget early. that is not what you do. it is about putting in the reforms for my generation so that we do not have a debt crisis. that way medicare and social security is there for my generation when we retire. the point we're trying to make is this. let's not have a european crisis on our hands. you know what happens then when the bond markets turn on you? they are slashing health benefits for current seniors. cranking up tax, slowing down the economy. young people cannot get jobs. what we're trying to do is this -- to get the economy growing and help workers and help small businesses and guarantee the promise of these programs. we need to change it for my generation.
>> maybe a couple more questions from minnesota, charles asks would you stabilize social security by increasing revenues, lowering or limiting benefit or a combination? >> so, mitt and i put a specific plan out here. we think that a tax increase on payroll taxes is bad for economics, bad for growth, and it especially hurts self-employed people. you have to remember, a self-employed person like a farmer or somebody working their own business pay both sides of the payroll tax and that hurts job creation and it doesn't get you the kind of revenues you need to fix the problem. if you put small changes now that don't kick in until people 54 and below retire, you can make the modest changes that make the program solvent for 75 years. what we're say something -- -- saying, is gradually raise that retirement age to reflect longevity in the future.
it would not even start until 2025, i believe. and don't give wealthier people as much of an increase in their benefits as everyone else does. bring that bottom benefit up to at least the poverty line. this is a flaw in the social security system today. there are people who live only on social security that are below the poverty line. that helps you afford to bring the minimum benefit up so there is nobody below the poverty level. doing it this way helps us save this program for current seniors, preventing the 25% cut in 2033, and makes sure it is there when i retire. the younger you get, the less you believe you're going to get this program. we should restore the trust is going to be there for us when we retire. [applause] >> a last question. i think it was fairly similar to
a last question the president took as well. lester asks, social security and medicare are too important for you to keep fighting in washington. what specific steps would you take to forge bipartisan compromise? >> it's the best question i could have been asked this entire time. first i think you might have heard the word voucher earlier today, right? that's a tested word designed to scare today's seniors. here's what a voucher is. a voucher is you go to your mailbox and you get a check and you go buy something and you're on your own. nobody is proposing that. what we're proposing is an idea that i propose with a democrat in the senate last year. an idea that came out of bill clinton's 1999 commission to save medicare. what we're proposing is an idea that has traditionally been supported by democrats and republicans in the past. the reason i am so familiar with
this idea is it works like the plan i have as a congressman, as a member of the federal employee work force. you get a list of guaranteed coverage options. you can't be denied. you pick your plan and medicare subsidizes your premiums. if you're wealthy you don't get as much. if you are middle you get the same that you get from medicare today and if you are poor or coverage. -- you get total ott of pocket coverage. doing it this way, for my generation, saves it with no changes for people in or near retirement. the shame is, it has been supported since the late 1990's. because the president will not act on it. that's why it didn't pass. they are rooted in bipartisan ideas. here is what i have done on this
issue. what he has done when he was governor, a republican governor of a democratic state. don't demean the opposite side. don't demagogue democrats. invite them into a coalition to talk with us to solve these problems. you see, you can get to common ground on these problems if you treat people with respect without compromising your principles and the very existence of this plan to save and strengthen medicare, a plan that has been supported republicans alike is proof that we can get this done this is precisely what we want to do. you see, our plan is to win the election and work with those democrats who want to work with us to save this critical program. that's what we are trying to achieve. it's too important to take this for granted to play politics. these are the two most important programs the government has created. too many americans depend on it for their health and retirement
security. the more we delay, the more we do nothing, the deeper the hole we dig. the sooner we act, the sooner we can fix it so that my generation can count on it and so that your generation will get it without any changes. if you wait, then it gets uglier. the solutions are that much harsher. that is the point we're trying to make. thanks, jane. >> congressman ryan, thank you for joining us today. [applause] >> see the first of the president rnl debates wednesday october 3, live on c-span, c-span radio and online at c-span.org. watch and engage. next on c-span, "washington
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